Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1985
Blood flow, sympathetic activity and pain relief following lumbar sympathetic blockade or surgical sympathectomy.
The physiological effects of local anaesthetic (bupivacaine), neurolytic (phenol) blockade and surgical ablation of the lumbar sympathetic chain were assessed in patients with peripheral vascular disease or sympathetic dystrophy. Local anaesthetic blockade in 49 patients resulted in significant decrease in pain, plantar sweating and in the vasoconstrictor ice response of the foot, as well as a significant increase in skin temperature and foot blood flow. Subsequent neurolytic blockade in 31 of these patients achieved an effective denervation as assessed by the same physiological measurements. The magnitude of changes in blood flow and sympathetic activity were similar for local anaesthetic and neurolytic blockade as well as in six patients who underwent surgical sympathectomy.
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Anaesth Intensive Care · Feb 1985
Historical ArticleThe introduction of local anaesthesia in Australia, January 19, 1885.
Medical journals in Australia between 1856 and 1884 were wont to publish many references to forms of local anaesthesia, probably because this form of pain relief was of assistance to lone practitioners in isolated country towns. Some of these methods are described, as is the first use of cocaine by A. S. ⋯ T. Rudall on January 19, 1885. As in journals elsewhere there followed a spate of articles reporting various aspects of cocaine and its usage, including an abortive attempt to find an alternative agent.
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Anaesth Intensive Care · Feb 1985
Randomized Controlled Trial Comparative Study Clinical TrialClinical comparison of atracurium and alcuronium in gynaecological surgery.
In a double-blind, prospective, randomised trial in 51 female patients, atracurium 0.6mg/kg provided acceptable intubating conditions more rapidly than did alcuronium 0.25 mg/kg. Atracurium produced more profound neuromuscular twitch suppression than alcuronium. ⋯ Two cases of sinus bradycardia were noted in the atracurium group, but hypotension was not a clinical problem in any patient. Atracurium appears to be a useful relaxant, but a smaller dose than that used here should be chosen for short procedures.
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Anaesth Intensive Care · Feb 1985
Indications for and complications of temporary transvenous cardiac pacing.
A prospective survey was conducted of the indications for and complications of 153 temporary transvenous cardiac pacing lead insertions in 148 patients. Pacing for bradyarrhythmias or potential bradyarrhythmias (Group I) accounted for 105 insertions, wide complex tachycardia (Group II) 17, and narrow complex tachycardia (Group III) 31 pacing electrode insertions respectively. The infraclavicular subclavian vein approach was used in 73%. ⋯ A complication occurred in 27 (18%) of 153 lead insertions, 11 (7%) were serious. No complication resulted in the death of a patient. Temporary transvenous pacing is safe and effective for the treatment of bradyarrhythmias and certain tachyarrhythmias.
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Anaesth Intensive Care · Feb 1985
Changes of body temperature and heat in cardiac surgical patients.
Changes in body temperature were assessed in ten adult patients undergoing surgery involving cardiopulmonary bypass (CPB) and induced hypothermia. Intraoperatively, in comparable time intervals before CPB and after rewarming, the patients lost body heat. Between the time of induction of anaesthesia and CPB, the temperature of blood in the pulmonary artery fell 1.46 (SD 0.28 degrees C); between CPB and the end of surgery the fall was 1.55 (SD 0.86 degrees C). ⋯ Intraoperative deep body temperatures demonstrated the expected exponential relationship with metabolic rate. Postoperatively, increase in metabolic rate was associated with rising deep body and skin temperatures. Low resistance to the flow of heat toward the skin surface was demonstrated by low postoperative values for thermal insulation, which may indicate good peripheral perfusion seen during continuing vasodilator therapy.